When RxHub, a joint venture of three pharmacy benefits managers, chose the National Council for Prescription Drug Programs standards for transmitting electronic prescriptions, privacy advocates spoke up. But the venture spurred on a pair of competitors.
A grocery/drug store chain and a drug store trade group say they, too, are building links for e-prescribing.
The NCPDP standard is, in effect, a rulebook on what information will flow in a prescription data transmission. Privacy concerns about the Phoenix-based NCPDP stem from the inclusion in its standards of an optional database field for diagnostic codes. The AMA has repeatedly opposed industry requests to include diagnoses in prescriptions, citing privacy concerns.
Yet, pharmaceutical manufacturers for years have tried to tie prescribing patterns to specific diagnoses, and now, with the HIPAA-approved NCPDP standard being adopted by e-prescribing software developers, physicians can be electronically enabled to do just that.
Moreover, because RxHub is a joint venture between AdvancePCS, Express Scripts and Merck-Medco, the three largest PBMs, it represents a threat to retail drug stores.
In September, the National Community Pharmacists Association and the National Association of Chain Drug Stores launched their own venture, called SureScript Systems, a two-way conduit that does not require prescriptions to flow through PBMs.
Meanwhile, Boise, Idaho-based Albertson's, the grocer that owns the Sav-On and Osco drug store chains, is developing its own system to communicate with physicians, PBMs, drug suppliers, insurers and patients.
Just as the PBMs put aside their competitive instincts to form RxHub, sponsors of these new data links joined hands last month to promote e-prescribing at an NCPDP educational forum in Orlando, Fla.
"We want to get in-office computer systems to go beyond billing," says Ken Whittemore Jr., a vice president of SureScript. "We know that one of the biggest time-consuming tasks for both the community pharmacist and physicians is the refill process."
"It's really about connectivity," says RxHub CEO James Bradley. "One of my nightmares at RxHub is that we throw a party and nobody comes. We've got to foster a healthy physician automation industry for this to work."
One advocate, Jack Newcomer, M.D., a solo family practitioner in West Palm Beach, Fla., spoke at the conference on the merits of electronic prescription refilling.
"We have to come up with a faster way because (insurers) are not going to pay us for sitting on the phone with a pharmacist," he says. "With that time, I could be seeing more patients or spending more time with each patient."
What remains to be decided is who will make the links. "We, as a retail pharmacy, believe the best connection is between the physician and the pharmacy," says Michael Simko, corporate manager for pharmacy services at Deerfield, Ill.-based Walgreen Co.
Meanwhile, Bradley says, "Retail pharmacies should be looking at (both) RxHub and SureScripts as solutions."